System and method for generating a patient-specific digital image-based model of an anatomical structure

ABSTRACT

Embodiments of the invention are directed to a method of performing computerized simulations of image-guided procedures. The method may comprise receiving medical image data and metadata of a specific patient. A patient-specific digital image-based model of an anatomical structure may be generated based on the medical image data and the metadata. A computerized simulation of an image-guided procedure may be performed using the digital image-based model and the metadata.

BACKGROUND OF THE INVENTION

Many invasive medical procedures such as for example endovascularprocedures can pose challenges even to the most experienced physicians.Tortuous anatomy, difficult visualization, complex lesion morphology,and other complications can add to increased procedure time, fluoroscopyexposure, and contrast dye use. Precious time can be lost if the accessstrategy or equipment choice is suboptimal. Accordingly, simulationsystems for image-guided procedures for training a physician withoutunnecessary risk, which may serve as pre-operative planning tool orpost-operative assessment tool, have been introduced.

BRIEF DESCRIPTION OF THE DRAWINGS

The subject matter regarded as the invention is particularly pointed outand distinctly claimed in the concluding portion of the specification.The invention, however, both as to organization and method of operation,together with objects, features and advantages thereof, may best beunderstood by reference to the following detailed description when readwith the accompanied drawings in which:

FIG. 1 shows an exemplary system for simulating an image-guidedprocedure according to embodiments of the invention;

FIG. 2 is a flowchart diagram illustrating a method for simulating animage-guided procedure based on patient metadata according to someembodiments of the present invention; and

FIG. 3 shows an exemplary screenshot related to a presentation of apatient-specific digital image-based model of an anatomical structureand a presentation of related metadata.

It will be appreciated that for simplicity and clarity of illustration,elements shown in the figures have not necessarily been drawn to scale.For example, the dimensions of some of the elements may be exaggeratedrelative to other elements for clarity. Further, where consideredappropriate, reference numerals may be repeated among the figures toindicate corresponding or analogous elements.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

In the following detailed description, numerous specific details are setforth in order to provide a thorough understanding of the invention.However, it will be understood by those having ordinary skill in the artthat the invention may be practiced without these specific details. Inother instances, well-known methods, procedures, components, modules,units and/or circuits have not been described in detail so as not toobscure the invention.

Embodiments of the invention are directed to generating a digital,image-based, model of an anatomical and/or physiological structure basedon medical image data and patient specific metadata. An anatomicaland/or physiological structure may be and organ, tissue or vessel, e.g.,a blood vessel, a heart, a bone or any applicable region, section or(possibly internal) part of a subject. Some embodiments of the inventionare directed to generating a digital, image-based, model that exhibits,simulates or is otherwise related to a physiological behavior based onmedical image data and patient specific metadata. A physiologicalbehavior of a digital model may be based on metadata. For example, adigital model related to a specific patient may simulate or be otherwiserelated to a physiological behavior of the specific patient based onmetadata related to the specific patient. For example, an interactionwith medical tools, a reaction to a drug, a reaction to events of aspecific patient may all be simulated, exhibited and/or performed by adigital model. Simulating a physiological behavior may include, forexample, blood vessel elasticity, rate of blood flow, response tocertain drugs or different drug dosage, bone strength, raptureprobability, sensitivity to radiation, vessel reaction to variousballoon inflation pressures etc. Accordingly, embodiments of theinvention may be used for a number of purposes. For example, in order toenable a performance of a simulated procedure that may be used fortraining of physicians, research, or demonstrating a procedure.

Embodiments of the invention may enable producing a patient-specificdigital image-based model of an anatomical and/or physiologicalstructure based on medical image data received from a scan of a subjectand further based on metadata of the patient that may be obtained orreceived as known in the art, e.g., in a digital imaging andcommunications (DICOM) image header. The subject may be, for example apatient that is about to undergo an image-guided procedure. According toembodiments of the invention, the medical images or other data may bepatient-specific medical images and parameters obtained from thepatient. For example, the medical images or other data may be obtainedfrom a specific patient and provided to embodiments of the invention byone or more imaging systems such as computed tomography (CT), aCT-fluoroscopy, fluoroscopy, magnetic resonance imaging (MRI),Ultrasound, positron emission tomography (PET) and X-Ray systems or anyother suitable imaging systems. Embodiments of the invention may use asinput medical image data described herein to produce a 2D, 3D or 4Dmodel of an anatomical structure, organ, system or region.

According to embodiments of the invention, a method of generating adigital, image-based model of an anatomical structure may includereceiving and incorporating or otherwise using, any data, parameters,metadata or other information related to a patient. For example, anyinformation or metadata related to a medical history or condition of apatient, known diseases, allergies, sensitivity to drugs and the likemay be regarded as metadata and used by embodiments of the invention ina generation of a digital image-based model of an anatomical andassociated physiological structure of the patient. Other metadata may bediagnostic information and/or opinions produced by one or morephysicians, test results, results from various systems, e.g., aradiology system. For example, based on medical conclusion and diagnosisof a radiologist, specific sections of a digital image-based model maybe enhanced. For example, the resolution of a specific section, area ororgan may be enhanced, e.g., by producing or synthesizing additional,artificial information such as artificial CT slices, synthesized X-Rayimages or other medical image data as described herein. In a particularcase, based on the radiologist diagnosis of percent of plaque occlusion(e.g., total occlusion in the right internal carotid), the image-basedmodel can be generated to reflect any aspects related to plaqueocclusion, possibly in a specific location.

According to embodiments of the invention, a simulated procedure may bebased on metadata. A digital image-based model may be manipulatedaccording to relevant or related metadata. For example, variousattributes, behavioral aspects or other parameters of a digitalimage-based model may be according to, or based on, metadata such asage, gender, medical condition or any applicable metadata related to thespecific patient in addition to the medical images described herein. Forexample, behavioral aspects of a digital model, e.g., interaction with asimulated medical tool or reaction to an administered drug exhibited bya digital model may be according to or based on metadata as describedherein.

For the sake of simplicity and clarity, any parameters, data orinformation other than image data received from an imaging system asdescribed herein may be referred to herein as “patient metadata” orsimply as “metadata” in order to distinguish such data from image data.Accordingly, age, gender, weight, height, life style, smoking or otherhabits, medical history or condition, known diseases or allergies asdescribed above, or any such relevant or applicable information may bereferred to herein as “patient metadata” or simply “metadata”. Asdescribed herein, embodiments of the invention may provide a user withvarious views of images and other medical data. In some embodiments, animage may be generated based on received raw medical image data,artificially generated medical image data, metadata or a combination ofmetadata, raw and artificial medical image data. For example, artificialdata may be a CT slice or image generated or synthesized by examining CTreceived from a CT system. In some embodiments, an image related to aspecific surface, point of view or imaging system may be generated basedon received raw medical image data, artificially generated medical imagedata and/or metadata. For example, based on metadata indicating aspecific point of interest, an image may be generated or displayed. Forexample, metadata indicating a specific organ may require specialattention may cause embodiments of the invention to generate an imagewhere the specific organ may be best viewed.

In a particular scenario, a 3D digital image-based model may begenerated based on input from a CT system as described herein. An X-Rayview may then be generated based on the digital image-based model and incorrelation with metadata such that a specific region or organ is bestviewed. For example, a two dimensional (2D) X-Ray view may be producedby projecting a three dimensional digital image-based model on a twodimensional surface or plane such that a specific organ is best viewedby a user. Embodiments of the invention may enable a user to select anX-Ray camera view, position or location with respect to a patient andproduce an X-Ray image or view that would have been provided by an X-Raycamera located at the selected location and/or position. Accordingly,artificial or synthesized X-Ray images or views may be generated andprovided even when no actual X-Ray camera is utilized for obtaining suchimages. Accordingly, based on metadata indicating a specific organ orregion require special attention, a user may request and/or be providedwith X-Ray like images of a region or organ of interest.

In an exemplary embodiment, data received from a CT system may be usedto generate a digital image-based 3D model and such model may further beused to generate a view that would have been provided by a camerafitted, for example, on a colonoscope used for examination of the colon.Accordingly, in such exemplary embodiment, views revealing internalaspects or views of the colon may be generated and displayed. Likewise,views or images related to any applicable technology or system may beproduced based on a digital image-based model. Accordingly, based onmetadata a physician or a system may have prior to a generation and/ordisplay of an image-based model, the physician may request and/or beautomatically provided with views that enable the physician to viewspecific regions or organs of interest. In some embodiments, based onmetadata, specific views (e.g., X-Ray like or internal views asdescribed herein) may be automatically generated. For example, based onmetadata indicating a patient suffers from an inflammatory disease ofthe intestines, views revealing internal aspects or views of the colonas described above may be generated and displayed.

The ability to generate views or images normally produced by varioussystems may be highly appreciated by those of ordinary skill in the art.Advantages of such ability may include a substantial saving of cost andtime since based on metadata and data received from a first imagingsystem, embodiments of the invention may provide output related to asecond, different system that may reveal aspects of interest asdescribed herein. Accordingly, the ability to synthesize and provideimages related to any angle, orientation, position or location of asimulated imaging device in accordance with metadata may be highlyappreciated in the industry as they may enable a physician toeffectively examine regions, organs or other aspects of interest. Insome embodiments, artificial views as described herein may be displayedin addition to, or instead of, an image-based model generated based onraw image data as described here.

As described herein, displaying of metadata may be integrated orcoordinated with, or otherwise related to a presentation, a progress orother aspects of a simulated procedure. In some embodiments,presentation of metadata may be according to a selection of a user. Forexample, a user may click a location on a simulated model, or otherwiseselect or indicate an interest in a location, anatomical organ or regionrelated to the simulated model and be provided with relevant metadata.In other embodiments, presentation of metadata may be automaticallysynchronized or otherwise coordinated with a progress, state, mode orcontext of a simulated procedure. For example, metadata related to alocation of a catheter, a wire, a stent or another simulated tool thatmay be shown in a simulated procedure may be automatically displayed.

In some embodiments, as a simulated medical tool is moved from a firstlocation to a second location, a first displayed metadata may beautomatically replaced by a second metadata (related to the secondlocation) such that metadata related to the second location is presentedinstead of metadata related to the first location. Accordingly, apresentation of metadata may be automatically synchronized, matchedand/or coordinated with a simulated procedure. For example, recent testresults related to a patient suffering from an inflammatory disease ofthe intestines may be displayed upon selecting, or clicking on, theintestines in a simulated model. In another embodiment, real X-Rays ofan anatomical organ may be displayed when a simulated medical tool isbrought close to the related simulated anatomical organ.

Reference is made to FIG. 1 showing an exemplary system 100 forgenerating an image-based digital model of an anatomical region.Exemplary system 100 may further be used for simulating an image-guidedprocedure according to embodiments of the invention. As shown, system100 may comprise a computing device comprising a number of units andoperatively connected to input and/or output (I/O) units. System 100 mayinclude input units 105, output units 120, a model generation unit 110,a simulation unit 115, a management unit 135, a data repository 140, apresentation unit 125, a memory 130 and a controller 131. Input units105 may include a network interface card (NIC) e.g., enabling system 100to communicate with a PACS system, a mouse, a keyboard, a touch screenor pad or any suitable input devices. Input units 105 may comprise meansfor operating simulation tools and tracking the user's manipulation ofsuch tools. For example, physical objects such as handles, activationbuttons and the like, as well as real or mock medical tools may beconnected to input units 105 to enable a user to operate simulated toolssuch as a simulated catheter, suturing device, surgical scalpel,scissors, endoscope etc.

Additionally or alternatively, input units 105 may include a wired orwireless network interface card (NIC) that may receive data, forexample, from an imaging system and may store obtained data, informationor parameters in local data repository 140. According to someembodiments, a mediator unit, e.g., a communication management unit mayutilize a NIC to communicate with a system or server storing medicalimages such as a picture archiving communication system (PACS), mayobtain any relevant imaging information, data or parameters from such asystem, server or application and may store obtained data, informationor parameters in local data repository 140. Output units 120 may includedisplay screens, speakers, components for interfacing with a displayscreen to enable visual output or optionally a speaker or another audiodevice to enable audible output. Output units 120 may include one ormore displays, speakers and/or any other suitable output devices. Outputunits 120 may additionally include force feedback components that mayapply, cause or generate physical forces or resistance (e.g., frictionlike resistance) to physical input devices that may be operated ormanipulated by a user. Output units 120 and input units 105 maycommunicate with any other component or units of system 100 andaccordingly may enable such units to communicate with external systems.Units 105, 110, 115, 125 and 135 may be or may comprise software,hardware, firmware or any suitable combination thereof. Output units 120may enable communicating data to external repositories, For example, aprocedure plan may be communicated via output units 120 to externalimage data repository 145, external metadata repository 147 or any othersystem that may store a procedure plan.

Also shown in FIG. 1 are an external image data repository 145, anexternal metadata repository 147 and an imaging unit 146. External imagerepository 145 may be any suitable or applicable database, repository orarchive. For example, external image data repository 145 may be apicture archiving and communication systems (PACS) archive orrepository. As known in the art, a PACS system may comprise computingand/or other devices that may be dedicated to the storage, retrieval,distribution and presentation of medical images. Images in a PACS systemmay be stored according to various formats, e.g., DICOM. A PACS systemtypically comprises or is operatively connected to an archiving systemfor archiving data such as CT, MRI or other images and related data, asecured network for the transmission of patient sensitive or privateinformation and possibly, computing devices to receive image or otherdata from the archiving system. Embodiments of the invention may beconfigured to interact with a PACS system, e.g., over a networkinterface card (NIC) connected to a network such that communication witha PACS system is enabled. External metadata repository 147 may be anysuitable or applicable database, repository or archive. For example,external metadata repository 147 may be a PACS archive or repository asdescribed herein. In some embodiments, the same PACS, repository ordatabase system may be used to implement or facilitate both externalmetadata repository 147 and external image repository 145. In someembodiments, external metadata repository 147 may be combined withexternal image data repository, e.g., in a PACS system or a DICOMsystem.

According to embodiments of the invention, a system (e.g., system 100)any interact with any applicable or suitable system in order to receiveor otherwise obtain data or metadata or in order to send (e.g., forstorage) information or metadata. Information stored according to anystandard or protocol may be obtained from any system that may beinteracted with over a network or directly connected to a system such assystem 100. Embodiments of the invention may send and/or receiveinformation according to any standard or protocol. For example,health-care patient records, data or metadata may be stored (e.g., by anexternal system or by system 100), sent or received by a systemaccording to embodiments of the invention according to protocols suchhealth level seven (HL7), electronic data interchange (EDI) or healthinformatics service architecture (HISA).

Management unit 135 may interact, e.g., over a network and possiblyaccording to and/or by implementing a predefined protocol, with externaldata repository 145 that may be a PACS system. CT, MRI or other imagesand related data may be thus retrieved, received or otherwise obtainedfrom such PACS or other system and may further be used as describedherein and/or stored or buffered, for example, in data repository 140.Management unit 135 may interact, e.g., over a network or over a directconnection such as a communication bus, with external metadatarepository 147 to retrieve any relevant, applicable or requiredmetadata. For example, parameters, data or information such as age,gender, weight, height, blood pressure, heart rate or any other vitalsigns, exercise habits, medical history and/or tests results, familyhistory, smoking habits, known diseases, allergies, sensitivity todrugs, X-ray or other images of various regions or any medical recordsthat may be available may all be obtained from external metadatarepository 147. It will be understood that for the sake of simplicityand clarity, a single external metadata repository 147 is shown inFIG. 1. However, system 100 may interact with any number of metadatarepositories in order to obtain any relevant, applicable or requiredmetadata.

In some embodiments, metadata repository 147 may interact with otherrepositories, e.g., in other medical facilities, in order to obtainedmetadata. In yet other embodiments, metadata may be provided to metadatarepository 147 and/or system 100 by means of a removable storage deviceand media such as a compact disc (CD) that may be connected to metadatarepository 147 or otherwise connected to system 100. Accordingly,embodiments of the invention are not limited by the type, nature orother aspects of a source of metadata nor by the way such metadata iscommunicated and/or received. Management unit 135 may interact with anycomponent of system 100 and may coordinate operations of system 100. Forexample, management unit 135 may coordinate operations of datarepository 140 and external data repositories such as external imagedata repository 145, imaging unit 146 and metadata repository 147, e.g.,in order to enable data repository 140 to receive any required data fromexternal repositories.

Imaging unit 146 may be an imaging system such as computed tomography(CT), a CT-fluoroscopy, fluoroscopy, magnetic resonance imaging (MRI),Ultrasound, positron emission tomography (PET) and X-Ray systems or anyother suitable imaging system. As shown, medical image data and/orrelated data may be received by external image data repository 145 fromimaging unit 146. External repository 145 may receive medical imagingdata from any other applicable source, e.g., over a network from aremote site or hospital or by means of a removable storage device thatmay be connected to repository 145. As shown, system 100 may receiveimage data and/or related data directly from imaging unit 146. Althoughnot shown, system 100 may receive imaging and/or other data from anyapplicable source, accordingly, embodiments of the invention are notlimited by the type, nature or other aspects of a source of medicalimaging or other data nor by the way such data is communicated and/orreceived.

Model generation unit 110 may include components or modules forgenerating a digital model and its graphical representation, e.g., a 3Danatomical model of an anatomical structure, such as an organ, vesselsystem or any other area of interest within a body of a subject. Themodel may be generated by model generation unit 110 according toinformation received from an imaging system, for example, a medicalimage received from a CT system via input unit 105. It will berecognized that embodiments of the invention are not limited by themethod or system for generating a digital image-based model of ananatomical structure, any methods or systems may be used for generatingsuch model without departing from the scope of the invention. Inaddition to being generated based on image data, the model may begenerated by model generation unit 110 according to metadata obtained asdescribed herein and possibly stored in data repository 140. Forexample, based on the medical analysis and measurements, a more accuratemodel may be generated. Any measurement, result, parameter or othermetadata obtained from a patient may be used in a generation of a model.For example, a measured diameter of various parts of a vessel may beused in a modeling of the vessel.

According to embodiments of the invention, a digital image-based modelmay be associated with various behavioral aspects. For example,simulation unit 115 may cause a model to behave or otherwise exhibittraits based on metadata. For example, the interaction of a model (or anorgan in the model) with a simulated medical tool may be specific to aspecific model. For example, in the exemplary case above, the model ofthe older patient having stiffer blood vessel walls may be reactdifferently to a catheter than the younger patient's model, e.g., whenthe catheter is pressed against a blood vessel's wall in the olderpatient's model, the wall may not yield or bend as much as a similarwall in the younger patient model. A digital image-based model may begenerated according to any other metadata, e.g., gender, weight, height,vital signs, exercise habits, medical history and/or tests results,family history, smoking habits, known diseases, allergies, sensitivityto drugs, X-ray or other images of various regions or any other medical,personal or relevant information

Simulation unit 115 may include components for generating a simulationof an image-guided procedure. For example, when a user performs asimulation, for example as a pre-procedure for an image-guidedprocedure, using simulation unit 115, a graphical representation of adigital model (e.g., produced by model generation unit 110), and thesimulation process may be displayed on a monitor that may be one ofoutput units 120. A generation of a digital model of an anatomicalorgan, system, section or region (e.g., by model generation unit 110)and a simulation of a procedure (e.g., by simulation unit 115) may beaccording to methods, systems and/or other aspects as described in USPatent Application Publication US 2009/0177454. A generation of adigital model of an anatomical organ, system, section or region may bebased or in accordance with metadata as described herein. Likewise, asimulation of an image-guided procedure may be based on, or accordingto, metadata. Simulation unit 115 may include components for generatinga simulation of an image-guided procedure based on metadata. Forexample, a simulated model may be caused by simulation unit 115 toexhibit, include or have attributes or characteristics related to therelevant metadata. For example, a sensitivity or reaction to a(simulated) administration of a drug, an interaction with a simulatedmedical tool or any other aspects or behavior of a simulated model maybe according to or based on metadata of the relevant patient.

Controller 131 may be any suitable controller or processing unit, e.g.,a central processing unit processor (CPU). Memory 130 may be anysuitable memory component, device, chip or system and may storeapplications or other executable codes that may be executed bycontroller 131 and/or data, e.g., data that may be used by applicationsor programs executed by controller 131. For example, executable code,applications or modules implementing model generation unit 110 and/orsimulation unit 115 may be loaded into memory 130 and executed bycontroller 131.

It will be recognized that system 100 as described herein is anexemplary system. According to embodiments of the invention, system 100may be implemented on a single computational device or alternatively, ina distributed configuration, on two or more different computationaldevices. For example, model generation unit 110 may operate on a firstcomputational device and managed by a first management unit whereassimulation unit 115 may operate on another computational device andmanaged by a second management unit that communicates with the firstmanagement unit. In another exemplary embodiment, management unit 135may operate on a computational device, model generation unit 110 mayoperate on a second computational device and simulation unit 115 mayoperate on a third computational device.

Presentation unit 125 may control, coordinate or manage a display orpresentation of video, audio or other aspects of a simulated procedureand related medical image data and metadata. For example, presentationunit 125 may receive data, parameters or other information from aplurality of sources and incorporate received or obtained data into apresentation to a user. Presentation unit 125 may coordinate,synchronize or otherwise relate a presentation of information from aplurality of sources within a single presentation.

For example, presentation unit 125 may coordinate or synchronize apresentation of metadata, e.g., a display of patient metadata asdescribed herein may be coordinated or performed simultaneously with apresentation and/or performance of an image guided simulated procedure.Alternatively or additionally, presentation unit may cause apresentation of metadata according to a user selection. For example andas further described herein, a selection of a region of interest may bereceived from a user and a presentation of relevant metadata may beaccording to such selection. Management unit 135 may interact with anymodule, unit, application or other applicable entity and may performcoordination, scheduling, arbitration, supervising and/or management offlows, procedures or other aspects as described herein. For example,presentation unit 125 may coordinate or synchronize a presentation of aprocedure plan.

Reference is made to FIG. 2, which shows an exemplary flowchartdescribing a method for generating a patient-specific digitalimage-based model of an anatomical structure and simulating animage-guided procedure according to some embodiments of the invention.The method may include receiving medical image data and metadata relatedto a specific patient that may be related to a specific subject orpatient about to be treated (box 210). The medical image data may bereceived directly from an imaging or scanning system such as forexample, a CT or MRI scanner or alternatively from an external imagedata repository, such as a picture archiving communication system(PACS). As will be understood to a person skilled in the art, themedical image data may be received from any other applicable source. Themetadata may be received directly from a metadata repository, databaseor any other source, e.g., metadata repository 147 described herein. Aswill be understood to a person skilled in the art, the metadata may bereceived from any other applicable source

According to some embodiments, the received medical data and metadatamay be stored locally or internally within a data repository, such asdata repository 140. According to some embodiments, possibly based onreceived data, data may be generated. For example, based on a set ofthree hundred (300) CT images and metadata as described herein, anextended set of six hundred (600) may be generated. For example, byexamining an initial set of images and by further examining metadatarelated to the specific patient, embodiments of the invention, e.g.,executable code executed by controller 131, may generate or produceadditional images and thus produce a new set of images. For example, ifa given set of images was produced by acquiring a single image per amovement of one centimeter (1 cm) of the imaging unit, a new set may beproduced by artificially generating images to reflect a movement of halfa centimeter (½ cm) of the imaging unit.

In some embodiments, based on two sequential images in an original setand further based on metadata as described herein, an additional imagemay be artificially generated, e.g., by observing variations between thetwo original images and by further observing various aspects reflectedby relevant metadata. For example, based on metadata as describedherein, embodiments of the invention may generate artificial images of aspecific area of interest. For example, based on metadata indicating aspecific disease or condition, related regions may require higherresolution. Accordingly, based on metadata, additional artificial imagesmay be generated in order to provide better view of specific regions.Such metadata based generation of images or other medical image data maybe automatic or it may be based on a user selection. For example, havingstudied metadata of a patient, a physician may determine a higherresolution of a specific region in a generated model is required. Insuch case, the physician may select regions to be generated with suchhigher resolution, or have such regions modeled based on a higher numberof images. Based on such selection, additional or artificial images maybe generated as described herein.

In other embodiments, generation of artificial images based on metadatamay be automatic. For example, system 100 may be configured toautomatically generate additional images, or ascertain a minimum numberof images per specific region is available based on a specificparameter, value or other criteria related to a metadata of a patient.For example, metadata indicating a heart possible condition may causegeneration of additional artificial images such that at least aresolution reflecting a movement of a quarter of a centimeter (¼ cm) ofthe imaging unit is achieved for the heart or a specific region aroundthe heart in the digital model. Any other rules or criteria may belikewise configured in relation to any metadata and/or modeled regionsor anatomical organs.

An artificially generated image may be inserted between two relevantoriginal images in order to produce a new set of images that may becoherent and may adequately represent the anatomy or other aspects of arelated patient. Such generation of images may enable embodiments of theinvention to provide better resolution, and enhance a correlation ofmedical data and a simulated procedure as described herein. Suchgeneration of images based on metadata may enable embodiments of theinvention to provide selective resolutions based on metadata thusprovide, possibly automatically, higher resolution for specific regionsof interest based on a medical condition or other aspects of a patientas reflected by the relevant metadata described herein. Since metadataavailable to embodiments of the invention as described herein may relateto highly relevant medical aspects of the patient, automatically,selectively and/or otherwise generating additional or artificial imagesbased on metadata, thus automatically and/or selectively increasing aresolution and/or accuracy of selected regions or anatomical organs in amodel, may be a highly appreciated aspect of the present invention. Aset of images, either as received or extended as described herein may bestored locally, e.g., in data repository 140.

As described herein, raw medical image data, e.g., acquired by, andreceived from an imaging system may be processed. Processing of medicalimage data may be performed prior to generating views or image basedmodels as described herein. For example, pixels for rendering may beproduced by interpolation applied to acquired pixels or other imagerelated data. For example, CT slices may be artificially generated byinterpolation of acquired CT slices. Windowing transformations as knownin the art may be another example of processing that may be applied tomedical image data by embodiments of the invention, e.g., in order toenhance, alter or otherwise modify aspects such as contrast orbrightness of an image that may be received from an imaging system ormay be artificially generated as described herein. Any such processingmay be based on metadata. For example, aspects such as contrast orbrightness of a specific region or anatomical organ may be enhanced oraltered based on metadata. For example, a known disease may be known toaffect a specific region or anatomical organ. Accordingly, based on anindication of such disease (or a possibility of such disease) inmetadata of a patient, the contrast or brightness of the likely to beaffected region or organ may be increased. In some embodiments, DICOMtags may be used. For example, DICOM tag name “WindowCenter” (0028,1050) and/or DICOM tag name “WindowWidth” (0028,1051) may be used insetting thresholds for a segmentation process or other operationsrelated to generating a patient-specific digital image-based model

As shown by box 215, the method may include generating a patientspecific model of an anatomical structure based on the medical imagedata and the metadata. Generation of an anatomical structure may bebased on examining and/or processing of medical data and metadata, e.g.,as received as shown by box 210 and/or generated as described herein. Incases where the imaging data is patient specific, e.g., is produced byimaging or scanning a real specific patient or is extended based onspecific patient image data and metadata, the anatomical model may bepatient specific too, namely, the model generated as described hereinmay represent a specific, real patient. Model generation may beaccording to methods or other aspects as described in US PatentApplication Publication US 2009/0177454. As further described herein,the digital model may be generated based on metadata. A patient specificmodel of an anatomical structure may be generated based on any metadatarelated to the patient, e.g., medical history, physician's diagnosis oropinion, medications the patient may be taking, etc.

For example, based on previous examinations, plaque type in a patient'sblood system may be known or deduced based on the patient's metadata,and the simulated model may be according to such known or deduced plaquetype. A plaque type may effect a simulation of a procedure. For example,if the plaque percentage of a stenosis is 60%, then the generated modelmay reflect such percentage. Metadata related to lesions may be anotherexample of metadata that may be used in a generation of a model and/orperformance of a simulated procedure as described herein. In someembodiments, a specific organ in a model may be generated or modeledbased on metadata. For example, incomplete information may besupplemented using metadata. For example, data received from an imagingsystem may only suffice in order to model a section of an organ, e.g., ablood vessel, but may be insufficient in order to model the entirevessel, or an additional section of the vessel that may be required. Insuch exemplary case, based on metadata identifying a specific organ as ablood vessel, model generation unit 110 may extend the blood vessel,e.g., by extrapolation, such that a sufficient portion of the bloodvessel is modeled. In other cases, pathologies or other phenomena may bemodeled based on metadata. For example, a lesion in a blood vessel, adeformation of an organ or other aspects may be modeled based onmetadata even if they are not reflected in imaging data, e.g., notreflected in CT images obtained from the patient.

As shown by box 220, the method may optionally include suggesting, basedon the metadata, a physical medical tool to be used in an image-guidedprocedure. For example, based on metadata a catheter model or type, aballoon type or size or a wire tip may all be suggested. As known in theart, different medical tools or medical tools types may be suitable todifferent patients and/or different patient conditions. For example, afirst catheter may be suitable for a young male patient suffering from afirst illness or condition, a second catheter may be suitable for ayoung female patient suffering from a second illness or condition and athird catheter may be suitable for an old female patient suffering froma third illness or condition. Accordingly, based on an illness, medicalcondition or any aspect that may be determined from metadata, a medicaltool such a catheter may be automatically suggested as shown by box 220.

As shown by box 225, the method may optionally include suggesting, basedon the metadata, a substance or drug to be administered to the patientin relation to an image-guided procedure. For example, based onmetadata, administering heparin (e.g., before deploying a balloon orstent) or nitroglycerin (e.g., when carotid spasm is simulated) and/oratropine (e.g., when specific blood pressure phenomena are simulated)may be automatically suggested by simulation unit 115. The type of drugsuggested to be administered may be selected based on metadata.

As known in the art, different drugs or medications may be suitable fordifferent patients and/or different patient conditions. For example, afirst drug and/or dosage may be suitable for a young female patientsuffering from a first illness or condition, a second drug and/ordosage, medication or substance may be suitable for a young male patientsuffering from a second illness or condition and a third drug and/ordosage, medication or substance may be suitable for an old male patientsuffering from a third illness or condition. Accordingly, based on anillness, medical condition and/or any aspect that may be determined frommetadata as described herein, a drug, medication or substance or a typeand dosage and/or rate of introduction thereof, e.g., a type, dosage andrate of administration of a sedative drug may be automatically suggestedas shown by box 225. It will be understood that any aspects related toan introduction or administration of a drug or substance may beautomatically suggested based on metadata as described herein. Forexample, the type and dosage of a drug or substance, rate and/orlocation of administration, or other means (e.g., intravenous or throughthe gastrointestinal tract) may all be suggested based on metadata asdescribed herein. Such automation of a selection of a drug or substanceto be administered as well as a method of administration and otheraspects as described herein may save time and further help avoidingwrong decisions and may accordingly be a highly valuable feature oraspect of the present invention. It will be understood that a number ofsuggested medical tools, substances and/or methods of administration maybe presented or displayed to a user who may select one of such number ofsuggested options.

According to some embodiments of the invention, an element to be usedmay be suggested based on metadata and/or a simulated model. In otherembodiments, an element may be automatically selected based on metadataof a patient. For example, a first stent may be suggested for a youngpatient and a second stent, better suited for an older patient may beautomatically suggested or selected based on the patient's age asindicated in metadata of the patient. Other elements may be selectedbased on a patient's metadata, e.g., an endograft used in abdominalaortic aneurysm (AAA) and/or thoracic aortic aneurysm (TAA) simulatedprocedures, a coil in a peripheral embolization simulated procedure, aclip to be used in an open neuro surgery simulated procedure or a sleeveto be used in an open abdominal surgery simulated procedure may all beautomatically suggested or even automatically selected, e.g., bysimulation unit 115, based on patient metadata.

According to embodiments of the invention, based on suggesting a medicaltool or substance as shown by optional boxes 220 and 225 and 230, themethod may include receiving a selection of a medical tool and of asubstance to be administered and element to use. According toembodiments of the invention, the suggestions of a medical tool,substance or element as described herein may be made graphically, e.g.,displayed on a display operatively connected to a computing device orcontroller, e.g., controller 131. Accordingly, a selection may beperformed by interacting with a display (e.g., in the case of a touchscreen) or using a point and click device and/or a keyboard as known inthe art. For example, a user may click on one of a number of displayedsuggested medical tools, elements, substances and/or methods ofadministration. In other embodiments, a medical tool, element and/orsubstance to be administered may be automatically selected based onmetadata or other considerations, aspects or criteria. For example,based on the age of the patient, a catheter may be selected, e.g., asmaller catheter may be selected for a young patient while a largercatheter may be selected for an older patient. Likewise, a first drugbest suited for a patient suffering from a specific first illness may beselected for administration while a second drug or medicament may beselected for a second patient suffering from a different second specificillness.

As shown by box 230, the method may optionally include suggesting, basedon the metadata, an element to be used in relation to an image-guidedprocedure. For example, based on a patient's age, a stent type or sizemay be suggested. Other elements that may be suggested may be anendograft, a coil, a clip and/or a sleeve. Any parameters related to anelement may be suggested. For example, a size, type, location ororientation of an element may all be suggested based on metadata datathat may be an age, gender, medical history and/or a diagnosis of aphysician, an indication of an element by a physician (that may haveexamined the patient in the past and indicated a preferred treatmentand/or element)

As shown by box 235, the method may include performing a simulation ofthe image-guided procedure based on the model of the anatomicalstructure, the metadata, the selected tool, the selected element andselected substance. As described herein, a simulation of an image-guidedprocedure may comprise simulating any aspects of the related actualprocedure. For example, a physician may operate medical tools, beprovided with feedback by a force-feedback system and the digital modelmay be made to exhibit real life behavior, e.g., react to medical toolsand/or administered drugs, assume states such as hyperemia or shock etc.Any aspect or behavior of the model and tools that may cause thesimulated procedure to be as real as possible may be performed, e.g., bycomponents of system 100 described herein. For example, controller 131may cause a model to exhibit any real life or real patient behaviorand/or reaction to a simulated medical tool and a simulatedadministration of drug or medicine.

According to embodiments of the invention, a simulated procedure maycomprise a graphical representation of an anatomical model that may bedisplayed on a monitor with additional information, such as simulatedmodels of (possible selected as described herein) medical or othertools. In some embodiments, the graphical representation of theanatomical structure or organ and of the tools and elements may exhibitreal anatomical or physical qualities, traits, features, nature oraspects, e.g., move, bend, contract, react to pressure or medicine,bleed etc. As described herein, qualities, traits, nature or otheraspects of a model may be based or according to metadata. For example, amodel may exhibit aspects, or behave like, a specific patient sufferingfrom a specific condition would. For example, a simulated heart rate,tendency to bleed, reaction to an introduced drug may all be accordingto metadata of the specific patient. A simulation of an image-guidedprocedure may comprise an image or graphical representation of ananatomical organ, e.g., a model as described herein, that may be rotatedor otherwise positioned, or may be made to imitate a real anatomicalsystem, e.g., change or evolve with time, change shape in response to anoperation of, or an interaction with a medical tool or substance, bleed,or otherwise present or display real anatomical organ's behavior andrelated tools, elements, medicine or other aspects in accordance withthe related metadata. For example, a catheter, stent or other tools,devices or elements may all be shown and further simulated. In caseswhere the medical image data and metadata used for generating a model asdescribed herein is patient specific, the model generated as describedherein may also be patient specific and, accordingly, a simulation of aprocedure as described herein may be patient specific, namely, reflect,simulate or be otherwise related to a real procedure performed on areal, specific patient. Accordingly, a physician may perform acomputerized simulation of the image-guided procedure as a pre-procedureof the actual surgery (e.g., a surgical rehearsal or surgicalsimulation), part of a planning procedure, as a training session or as apost-procedure.

As shown by box 240, the method may include presenting metadata duringthe performance of the simulation of the image-guided procedure. Forexample, presentation of related metadata may be performedsimultaneously or concurrently with performance of a related simulationof an image-guided procedure, or it may be otherwise at the same time.In some embodiments, presentation of metadata may be synchronized orotherwise coordinated with a progress, state, mode, context or anyrelevant aspect of a simulated procedure. In cases where the metadata isrelated to a specific patient and, accordingly, the model and simulationdescribed herein may be patient specific as well, patient specificmetadata may be presented together with the simulated procedure, e.g.,while the simulated procedure is in progress. For example, a singledisplay may be used to present metadata and a simulated procedure at thesame time, e.g., as shown in FIG. 3.

Reference is additionally made to FIG. 3 showing an exemplary screenshot300 related to an integrated presentation of a simulated medicalprocedure, metadata and/or other information according to embodiments ofthe invention. As shown by FIG. 3, a display may be divided into anumber of regions, for example, four regions 310, 320, 330 and 340. Afirst region 310 may be related to the simulated procedure and mayaccordingly present a patient-specific digital image-based model of ananatomical structure. In this exemplary display, the image-based modelrepresents a vessel. Region 310 may further display a simulated orvirtual medical tool model representing a physical intervention medicaltool manipulated by a user during a simulated procedure. For example, acatheter 312 may be shown with relation to blood vessels 311. Asimulated procedure may comprise showing a movement of the catheter,e.g., as a result of actions taken by a physician, as well as reactionor other behavioral or other aspects of the anatomical organs and tools(e.g., based on metadata as described herein). For example, as thesimulation progresses, catheter 312 may be shown to move through bloodvessels 311, and blood vessels 311 may be shown to move, bend orotherwise react or exhibit phenomena typically seen or exhibited by realliving organs. Such behavior of blood vessel 311 may be according tometadata as described herein. For example, a blood vessel 311 of apatient suffering from a disease known to cause highly calcified bloodvessels may be made to bend or otherwise react differently to catheter312 than blood vessel 311 of a healthy patient.

As shown by 320 in FIG. 3, a second region or area may be dedicated orrelated to presenting related metadata. For example and as shown, apatient's age, weight and other metadata information may be shown. Asdescribed herein, various information, presentation modes and otherfeatures may be enabled with respect to the presentation of metadata.For example, presentation of metadata in region 320 may be correlated orsynchronized with a location of a simulated tool or part of a simulatedtool that may be shown in the simulation region 310. For example,metadata related to a specific location or region may be displayed inregion 320 when catheter 312 or the tip of catheter 312 is in closeproximity to such specific location or region.

For example, metadata related to a first location may be presented inregion 320 when the tip of catheter 312 is within a predefined distancefrom such first location. As the simulated procedure progresses andcatheter 312 is moved to a second region or location, metadata relatedto such second location or region may be presented in region 320, forexample, while the tip of catheter 312 is within a predefined distancefrom such second location. Correlation, synchronization, coordinationand/or integration of a simulated model and/or procedure with apresentation or related metadata as described herein may be implementedand/or performed according to any applicable design or configuration.For example and as shown by FIG. 1, presentation unit 125 may interactwith simulation unit 115 in order to obtain any relevant information orparameters related to a state, context, progress or other aspect of asimulation. Presentation unit 125 may further interact with datarepository 140 (or any other applicable data repository) in order toobtain relevant metadata and further cause display of such metadata.Accordingly, possessing any relevant information related to thesimulation and metadata, presentation unit 125 may coordinate,synchronize or otherwise relate a presentation of metadata with thesimulated procedure.

For example, as the simulated model used for a simulated procedure maybe generated based on metadata, the simulated model may includereferences to related metadata. As known in the art, cross referencesrelated to a number of objects, structures or elements may be used inorder to relate digital elements, data objects or other structures toone another. For example, a specific region or volume of a simulatedmodel may be generated based on, or in accordance with specific metadataas described herein. Accordingly, cross references related to elementsin a simulated model and metadata information, parameters or elementsmay be maintained and used in order to correlate, coordinate,synchronize or otherwise relate a presentation of a simulated modeland/or procedure with the relevant metadata. For example, presentationunit 125 may receive or obtain a reference to a metadata parameter(e.g., a specific value) based on which a model was generated (e.g., bymodel generation unit 110) and may use such reference to retrieve therelevant metadata parameter or value from repository 140 and furtherdisplay metadata parameter as shown by 320. Any presentation combiningan integrated presentation of metadata and a simulated model asdescribed herein may be generated. For example (although not shown)rather or in addition to displaying metadata in region 320, metadata maybe displayed in the simulation region 310. For example, using crossreferences as described herein, metadata related to a specific region oranatomical organ may be displayed near, on (e.g., in overlay mode) orclose to the region or organ.

As shown by 330, a third region may be used for displaying instructions,suggestions or other guidance to an operator of system 100. Suchguidance may be based on metadata. For example, based on metadataindicating a possible sensitivity of a patient to a specific drug, asuggestion to reduce the amount of such drug may be displayed in region330. Another example may be a suggestion to increase a dosage or toadminister a specific substance. For example, based on metadata it maybe determined that the patient may require a blood diluting substancethat may ease or help performance of the procedure. Accordingly, asuggestion to introduce a suitable medicament or substance may bepresented in region 330.

According to embodiments of the invention, parameters to be monitoredmay be defined or selected. Conditional operations may be defined for,and associated with, monitored or tracked parameters. For example,simulated vital signs, e.g., a blood pressure or heart rate of asimulated model may be monitored. Alarm conditions or other criteria maybe associated with monitored parameters. For example, according to adefinition or a selection of a user, an alarm may be triggered when aheart rate signal generated by a digital model exceeds a predefinedrate. Monitoring parameters, conditions or other aspects related to adigital model may be according to any criteria, rule, threshold, limit,amount, level or other quantity or parameter. Monitoring parameters maybe performed in real-time, for example, a patient's vital sign may bemonitored while a simulated procedure is in progress, e.g., as may bedone during an actual (non-simulated) procedure. Indicating an alarm,and/or otherwise providing information related to tracked or monitoredparameters may be done in real-time. For example, indicating an exposureduration time has been exceeded may be performed in real-time, during asimulated procedure. Any information related to monitored parameters maybe stored. For example, a stored procedure plan may include valuesrelated to tracked parameters. For example, upon detecting an alarmcondition, the time the alarm occurred (e.g., relevant time from thebeginning of the procedure), the value, level or amount that caused thealarm condition and any other relevant information may be recorded,e.g., in a procedure plan. Other recording schemes may be possible, forexample, recording information related to monitored parameters may beperiodic, continuous or otherwise performed.

As shown by 340, a fourth region may be used for displaying alarms orother indications that may be generated based on metadata. For example,based on metadata one or more limits related to exposure to radiationmay be computed. For example, maximum exposure duration and/or radiationintensity related to an old patient may not be the same as those relatedto a young patient. Other criteria, e.g., gender, sensitivity to drugsetc. may all be relevant to various aspects of the procedure.Accordingly, alarms, warnings or other indications may be generatedbased on the procedure and the metadata and may be displayed in region340 as described. Other regions (not shown) may comprise user interfaceelements, e.g., graphical user interface (GUI) objects, that may enablea user to control various aspects of a simulated procedure and displayof medical data as described herein. For example, various aspects, e.g.,color of warnings, sound etc. may be selected or controlled, e.g., asknown in the art. In other embodiments, other regions may be shown on adisplay. For example, a CT slice related to a location of a medical toolmay be shown, e.g., in a separate region or overlaid on the model.

Presentation of metadata may be automatic, e.g., according to variousconstraints, conditions, event or other aspects related to a simulatedprocedure. In some embodiments of the invention, metadata may beautomatically selected, presented, replaced or otherwise manipulated,e.g., based on a progress, state and/or context of a related to asimulated procedure. For example, a checkbox (not shown) may enable auser to select a mode of presenting metadata according to a location ofa tool or part of a tool. For example, checking a “follow tip” checkboxmay cause embodiments of the invention to update a presentation ofmetadata based on the location of a tip of a simulated catheter, e.g.,the tip of catheter 312. It will be understood that other arrangementsof regions 310, 320, 330 and 340 may be possible and/or userconfigurable. Accordingly, presentation of metadata may be according toa progress of a simulated procedure. Alternatively or additionally,metadata may be presented based on a selection of a location or regionin the simulated model. For example, upon detecting a selection, e.g., aclick of a mouse on a specific location or element of a simulated model,the relevant metadata may be displayed, e.g., in a dedicated region orarea such as region 320 in FIG. 3. Accordingly, a physician may bepresented with metadata with respect to a simulated model. Suchpresentation may be performed during a progress of a simulated procedureor in offline mode. For example, the physician may pause, stop orterminate a simulated procedure, examine the simulated model (that maybe static or frozen), and further select to review metadata related to aspecific location in the model, e.g., by clicking a location of intereston the model. Presenting metadata based on a selection of a location ona simulated model may be accomplished by utilizing cross references asdescribed herein.

Referring back to FIG. 2 and as shown by box 245, the flow may includeguiding a user in performing the image-guided procedure based onmetadata and a progress of the simulated image-based procedure. Forexample, guidance may be provided in region 330 of FIG. 3 as describedherein. As shown by box 250, the flow may include determining, based onthe metadata and a progress of a simulation of an image-guidedprocedure, an alarm condition and providing an indication of the alarmcondition. For example, various aspects of the simulated model (e.g.,heart rate, temperature etc.) may be related to metadata and an alarmcondition may be determined accordingly. For example, while a specificheart rate of an old patient may be determined to be too high ordangerous and cause an alarm to be generated and provided to an operatorof system 100, the same heart rate, when the patient is a young childmay not cause an alarm to be generated. Likewise, while a specific heartrate immediately after an introduction of a drug may be considerednormal (e.g., if the drug is known to increase heart rate), the sameheart rate may cause an alarm to be generated and displayed or providedif a specific time period has elapsed since introduction of the drug.Accordingly, alarms, warnings or other indications may be based, atleast in part, on the relevant metadata and/or a progress of thesimulated procedure.

As shown by box 255, the flow may include storing information related tothe a simulation of the image-guided procedure in a database. Forexample, an entire simulated procedure, including metadata displayed,operator's actions, snapshots of the simulation and any informationdisplayed or otherwise provided may be recorded and stored, e.g., on aPACS archive or any suitable or applicable database, repository orarchive. Selection, suggestion and/or usage of tools, drugs and elementsin a simulated procedure may be all be recorded and stored. For example,an entire simulated procedure and any relevant information, data orparameters may be stored as a procedure plan that may be used at a laterstage in order to plan, or prepare for, a real procedure, e.g., a realprocedure performed on the patient associated with the metadata.

For example, a procedure plan stored as shown by box 255 may includetools, elements and drugs suggested and selected during a simulatedprocedure so that any suggestion or selection made during a simulatedprocedure may be shown or indicated to a physician, e.g., by replayingthe simulated procedure or by otherwise providing information in astored procedure plan. Other parameters or data in a stored procedureplan may be a C-arm position, orientation or angulation, any relevantlesion data and/or a simulated image. A procedure plan may be stored inany storage. Generally, primary metadata or primary metadata storage asused herein may refer to metadata content or storage used for reading orobtaining metadata as well as writing or storing metadata. For example,a DICOM header may be used as a primary metadata storage by readingmetadata from the DICOM header, e.g., in order to generate a digitalmodel based on the metadata and writing metadata to the DICOM header(e.g., using a DICOM tag), for example, any results, comments or otherinformation related to a simulated procedure or a procedure plan may bewritten to a DICOM header or other primary metadata storage or content.For example, a primary metadata storage (that may be or may be includedin metadata storage 147) may store a procedure plan. In otherembodiments, a PACS system may be used to store a procedure plan, e.g.,in a DICOM header related to the specific patient.

A procedure plan may include any relevant aspect. For example, aposition of an X-Ray camera, a route or navigation of a catheter, a toolselection, a drug used, an element (e.g., a stent type and properties)may all be recorded as part of a procedure plan. Any other informationmay be stored in association with a procedure plan. For example, anymetadata or image data (e.g., one or more CT slices or images) may bestored as part of, or in association with, a procedure plan. Anotherexample of data that may be part of a procedure plan may be an X-Rayview produced or synthesized from a digital image-based model asdescribed herein. Generally, a procedure plan may be a plan for anupcoming procedure, may determine or suggest an approach, interventionaltools, address potential complications, relate to aspects such as aC-arm position or angle (possibly for specific steps in a procedure),provide lesion view and data etc.

A stored procedure may, at any time, be loaded, e.g., into system 100and replayed, e.g., for training, tutoring or other applicable purposes,e.g., a preparation for a procedure. In a particular embodiment, usingDICOM, information may be stored in association with DICOM images orother objects, e.g., as metadata associated with DICOM information. Byusing a procedure plan, a real procedure may be improved, for example,exposure to radiation may be reduced and/or procedure time may beshortened as the physician may be better prepared for the real procedureby reviewing, replaying or other using the procedure plan. For example,a procedure plan may be presented (e.g., replayed) to a physician duringa real or actual procedure.

Embodiments of the invention may include an article comprising anon-transitory computer-readable storage medium, having stored thereoninstructions, that when executed on a computer, cause the computer toreceive medical image data related to a specific patient, receivemetadata related to the specific patient and generate a patient-specificdigital image-based model of an anatomical structure of the specificpatient based on the medical image data and the metadata. When executedon a computer, the instructions may cause the computer to perform acomputerized simulation of an image-guided procedure using the digitalimage-based model and the metadata and manipulate the digitalimage-based model based on the metadata. An article according theembodiments of the invention may be or include units, modules,components or elements such as a computer or processor non-transitoryreadable medium, or a computer or processor storage medium, such as forexample a memory, a disk drive, or a USB flash memory, encoding,including or storing instructions, e.g., computer-executableinstructions, which when executed by a processor or controller, carryout methods disclosed herein.

Although embodiments of the invention are not limited in this regard,the terms “plurality” and “a plurality” as used herein may include, forexample, “multiple” or “two or more”. The terms “plurality” or “aplurality” may be used throughout the specification to describe two ormore components, devices, elements, units, parameters, or the like.

Unless explicitly stated, the method embodiments described herein arenot constrained to a particular order or sequence. Additionally, some ofthe described method embodiments or elements thereof can occur or beperformed at the same point in time or overlapping points in time. Asknown in the art, an execution of an executable code segment such as afunction, task, sub-task or program may be referred to as execution ofthe function, program or other component.

Although embodiments of the invention are not limited in this regard,discussions utilizing terms such as, for example, “processing,”“computing,” “calculating,” “determining,” “establishing”, “analyzing”,“checking”, or the like, may refer to operation(s) and/or process(es) ofa computer, a computing platform, a computing system, or otherelectronic computing device, that manipulate and/or transform datarepresented as physical (e.g., electronic) quantities within thecomputer's registers and/or memories into other data similarlyrepresented as physical quantities within the computer's registersand/or memories or other information storage medium that may storeinstructions to perform operations and/or processes.

While certain features of the invention have been illustrated anddescribed herein, many modifications, substitutions, changes, andequivalents may occur to those skilled in the art. It is, therefore, tobe understood that the appended claims are intended to cover all suchmodifications and changes as fall within the true spirit of theinvention.

What is claimed is:
 1. A method of simulating an image-guided medicalprocedure, the method comprising: receiving, by a computing device,medical image data related to a specific patient; receiving, by thecomputing device, medical history metadata related to health-carepatient records of the specific patient, the medical history metadatanot including the medical image data; and generating, by the computingdevice, a patient-specific digital image-based model of an anatomicalstructure of the specific patient based on the medical image data andthe medical history metadata, wherein the patient-specific digitalimage-based model exhibits a simulated patient-specific physiologicalbehavior based on the medical history metadata, and the simulatedpatient-specific physiological behavior includes any of an interaction,reaction or response; wherein the patient-specific digital image-basedmodel comprises a three-dimensional (3D) anatomical model of ananatomical structure; and wherein the patient-specific digitalimage-based model is displayed on a display; and using thepatient-specific digital image-based model in a simulation of theimage-guided medical procedure, the simulation comprising applying aforce feedback to a physical medical tool operated by a physician usingthe simulation, the simulated patient-specific physiological behaviorincluding that the patient-specific digital image-based model'sinteraction with the physical medical tool is based in part on themedical history metadata.
 2. The method of claim 1, comprisingmanipulating the digital image-based model according to the medicalhistory metadata.
 3. The method of claim 1, comprising: suggesting, bythe computing device, based at least in part on the medical historymetadata, at least one physical medical tool to be used in theimage-guided procedure; receiving, at the computing device, a selectionof a physical medical tool from a user; and providing a simulated modelof the selected physical medical tool, wherein the simulation comprisesmanipulating the simulated model of the selected physical medical tool,and the simulated patient-specific physiological behavior comprises aninteraction with the simulated model of the physical medical toolaccording to the medical history metadata.
 4. The method of claim 1,comprising: suggesting, based at least in part on the medical historymetadata, a dosage of a substance to administer; and receiving aselection of a dosage of a substance, wherein the simulatedpatient-specific physiological behavior comprises a reaction to theselected dosage of a substance according to the medical historymetadata.
 5. The method of claim 1, wherein the simulation comprises:detecting, based at least in part on the medical history metadata, analarm condition; and indicating the alarm condition to a user.
 6. Themethod of claim 1, comprising generating artificial medical image databased on the received medical image data, and based on the medicalhistory metadata.
 7. The method of claim 1, wherein the medical imagedata is received from one of: a computerized tomography (CT) system, amagnetic resonance imaging (MRI) system, a X-Ray system, a positronemission tomography (PET) system, an Ultrasound system, a picturearchiving and communication systems (PACS) archive and a fluoroscopysystem.
 8. The method of claim 1, comprising storing the computerizedsimulation procedure as a procedure plan in at least one of: a patient'sprimary metadata and a DICOM header.
 9. An article comprising anon-transitory computer-readable storage medium, having stored thereoninstructions, that when executed on a computer, cause the computer to:receive medical image data related to a specific patient; receivemedical history metadata related to health-care patient records of thespecific patient not including the medical image data; generate apatient-specific digital image-based model of an anatomical structure ofthe specific patient that exhibits a simulated patient-specificphysiological behavior, wherein the simulated patient-specificphysiological behavior is based on the medical image data and themedical history metadata related to at least one of the health-carepatient records of the specific patient and the patient-specific digitalimage-based model is to be used in a computerized simulation of theimage-guided medical procedure, wherein the patient-specific digitalimage-based model comprises a three-dimensional (3D) anatomical model ofan anatomical structure, and wherein the patient-specific digitalimage-based model is displayed on a display; and simulate animage-guided procedure using the patient-specific digital image basedmodel, the simulation comprising applying a force feedback to a physicalmedical tool operated by a physician using the simulation, the simulatedpatient-specific physiological behavior including that thepatient-specific digital image-based model's interaction with thephysical medical tool is based in part on the medical history metadata.10. The method of claim 1 wherein the patient-specific metadatacomprises one or more of: information related to a medical history orcondition of a patient, diseases, allergies, sensitivity to drugs, andage.
 11. The method of claim 1 wherein any of the interaction, reactionor response comprise one or more of blood vessel elasticity, rate ofblood flow, response to certain drugs or different drug dosage, bonestrength, rupture probability, sensitivity to radiation, and vesselreaction to various balloon inflation pressures.
 12. The article ofclaim 9, wherein the computerized simulation comprises manipulating thedigital image-based model according to the medical history metadata. 13.The article of claim 9, wherein the instructions when executed furthercause the computer to: suggest, based at least in part on the medicalhistory metadata, at least one physical medical tool to be used in theimage-guided procedure; receive a selection of a physical medical toolfrom a user; and provide a simulated model of the selected physicalmedical tool, wherein the simulation comprises manipulating thesimulated model of the selected physical medical tool and wherein saidsimulated physiological behavior comprises an interaction with thesimulated model of the physical medical tool according to the medicalhistory metadata.
 14. The article of claim 9, wherein the instructionswhen executed further result in: suggesting, based at least in part onthe medical history metadata, a dosage of a substance to administer; andreceiving a selection of a dosage of a substance, wherein said simulatedphysiological behavior comprises a reaction to the selected dosage of asubstance according to the medical history metadata.
 15. The article ofclaim 9, wherein the instructions when executed further result in:detecting, based at least in part on the medical history metadata, analarm condition; and indicating the alarm condition to a user.
 16. Thearticle of claim 9, wherein the instructions when executed furtherconfigure the computer to generate artificial medical image data basedon the received medical image data, and based on the medical historymetadata.
 17. The article of claim 9, wherein the medical image data isreceived from one of: a computerized tomography (CT) system, a magneticresonance imaging (MRI) system, a X-Ray system, a positron emissiontomography (PET) system, an Ultrasound system, a picture archiving andcommunication systems (PACS) archive and a fluoroscopy system.
 18. Thearticle of claim 9, wherein the instructions when executed furtherconfigure the computer to store the computerized simulation procedure asa procedure plan in at least one of: a patient's primary metadata and aDICOM header.
 19. A non-transitory computer readable storage mediumhaving instructions stored thereon that when executed by a computingdevice result in: receiving medical image data related to a specificpatient; receiving, by the computing device, medical history metadatarelated to health-care patient records of the specific patient, themedical history metadata not including the medical image data; andgenerating, by the computing device, a patient-specific digitalimage-based model of an anatomical structure of the specific patientbased on the medical image data and the medical history metadata andusing the patient-specific digital image-based model in a simulationwherein the patient-specific digital image-based model exhibits asimulated patient-specific physiological behavior based on the medicalhistory metadata, the simulation comprising applying a force feedback toa physical medical tool operated by a physician using the simulation,the simulated patient-specific physiological behavior including that thepatient-specific digital image-based model's interaction with thephysical medical tool is based in part on the medical history metadata.20. The non-transitory computer readable storage medium of claim 19,wherein the instructions when executed further result in performing thecomputerized simulation of the image-guided procedure using thepatient-specific digital image-based model.